Patiromer Efficacy to Reduce Episodic Hyperkalemia in End Stage Renal Disease Patients

Inclusion Criteria: * Males and Females, age at least 18 years * ESRD treated with thrice-weekly HD for ≥ 6 months. * At least two measured pre-dialysis serum \[K\] ≥ 5.5 mEq/L or one \[K\] ≥ 6.0 mEq/L noted over the past three months * Current use of dialysate with potassium concentration ≤ 2 mEq/L * Typical consumption of at least two meals per day * Have received customary dietary instruction over prior month * Considered by the treating physician(s) to be in otherwise stable clinical condition. * If patient is of childbearing potential, he/she will be willing to avoid pregnancy during the study using an acceptable birth control method. Exclusion Criteria: * Not considered by the treating physician(s) to be adherent with recommended dialysis schedule and prescribed medications * Life expectancy \< 3 months * Dialysis-dependent for less than 6 months * Non-elective hospitalization in prior 3 months * Currently prescription of oral potassium supplements * In the prior 3 months, therapy with oral potassium-lowering medication * Underlying severe gastrointestinal disorders, including history of ischemic bowel. * Corrected serum calcium concentration \> 10.5 mg/dL in prior three months * Anticipated kidney transplant within the next 3 months * Prisoners or others who are involuntarily incarcerated or detained * Pregnant, breastfeeding, or considering pregnancy. * Participation in a clinical trial of an experimental treatment within the past 30 days